REM sleep behavior disorder: Symptoms, risk factors, and treatment

The rapid eye movement (REM) sleep phase occurs approximately 90 minutes after a person goes to sleep.  During REM sleep, the brain is very active, often resulting in vivid dreams. REM sleep is marked by rapid eye movements, irregular breathing, and temporary paralysis.  The temporary paralysis in REM sleep prevents the sleeper from acting out dreams.


Symptoms

A person with REM sleep behavior disorder (RBD) experiences loss of paralysis, which results in him or her acting out dreams.  While people without RBD rarely make any movements during REM sleep, people with the disorder perform actions they made in their dreams, such as:

• Jumping out of bed

• Kicking

• Punching

• Talking or yelling


Unlike sleepwalking, people with RBD do not have their eyes open, walk, or leave their rooms. 

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When they have awakened, people with RBD remember details of the dream they were having.  However, they might not be aware that they were acting it out. 


Risk factors

Risk factors for RBD include being male, being older than 50 years of age, and having a neurodegenerative disorder. 

Recent research published in the journal Neurology also suggests that environmental factors, such as smoking, a recent head injury, pesticide exposure, are possible risk factors for RBD.

Treatment and management

Management and treatment of RBD involve injury prevention and medication. 


The patient's sleeping area must be made into a safe environment, and sharp objects and weapons must be removed.  If the patient has a bed partner and tends to become violent during sleep, his or her partner might need to sleep in another room.  Other precautions include padding the bedroom floor and reinforcing windows.

Clonazepam, a drug used to treat seizures and panic disorders, has proven to be very effective in treating RBD in 90 percent of patients.  Clonazepam needs to be taken by RBD patients indefinitely, as stopping can lead to recurrence of RBD.  It controls the symptoms but does not cure RBD.

Other drugs used to treat RBD include tricyclic antidepressants and melatonin. 

Patients who have RBD with no discernible cause can rely on management and medication to treat their symptoms for the long-term.  People who suspect that they might have RBD should consult a physician for a diagnosis and to determine whether an underlying neurological condition causes it. 

Dr. Lisa Marie Cannon is a physician who specializes in treating sleep disorders.  For related articles and news, subscribe to this blog.

Obese Men Face Higher Risk of Pneumonia, Study Says

Obesity among men has been linked to an increased risk of pneumonia, according to a study conducted by Danish researchers. The authors, however, cautioned that the link occurs more strongly with diseases associated with obesity, rather than with obesity itself. Previous studies on the relationship between the two conditions had been plagued by inconsistent results. To gain a better understanding of the link, authors looked at data from the Danish Diet, Cancer, and Health Study, which recorded samples from nearly 50,000 Danes.

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Statistical analysis of the sample showed that moderately obese men (those with a Body Mass Index (BMI) between 30 and 34.9) had a 40 percent higher risk of developing pneumonia compared to those who were of normal weight (a BMI of less than 24.9). Morbidly obese men (those with a BMI greater than 35) were seen to be twice as likely to suffer from pneumonia. There was no risk difference seen in women. 

Authors of the study are unsure why there is a gender difference, but postulate that fat distribution may be a major factor. An apple shape – which is usually the shape men form when they gain weight – can reduce ventilation in the lungs. 

However, obesity was seen as a working factor for most of the comorbidities of pneumonia. For example, diabetes (which several studies conclude is related to weight) has also been associated with a 25 to 75 percent increased risk for pneumonia.

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This study was concluded in 2010 and many health professionals have asked for newer research to be conducted. With more advanced medical technologies, scientists can determine the exact relationship between obesity and pneumonia. 

As a leading pulmonologist, Dr. Lisa Mare Cannon has extensive knowledge on respiratory disorders and their associated diseases. Follow this Twitter account to learn more about her field of medicine.

Asthma-COPD overlap syndrome: The result of lung airway remodeling

Asthma-COPD overlap syndrome or ACOS accounts for up to a quarter of all obstructive airway diseases. Patients afflicted with it usually exhibit worse symptoms when compared to patients with asthma or chronic obstructive pulmonary disease (COPD) alone. ACOS is not well recognized because asthma and COPD have almost similar manifestations. Most patients suffering from this disease are smokers who exhibit persistent expiratory airflow obstruction despite treatment.

Asthma and COPD are widespread respiratory disorders that cost billions of dollars in healthcare-related expenses every year. Both diseases, when not properly diagnosed and treated, may escalate to worse conditions and even death.

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ACOS is characterized by a phenomenon called “remodeling.” This consists of any or a combination of the following:

• Mucosal edema, mucus hypersecretion, and formation of mucus plugs.
• Hypertrophy and hyperplasia of the airway smooth muscle 
• Increased wall thickness of the respiratory tract

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Awareness of ACOS is growing and approaches for how to best manage this condition are being assessed to achieve the best possible results. There is a consensus among physicians that patients with features of both asthma and COPD experience frequent exacerbations, suffer from rapid decline in lung function, have poor quality of life, have high mortality, and on rare occasions, incur chronic inflammation even outside the respiratory system.

Dr. Lisa Marie Cannon is a recognized internist, specializing in pulmonary medicine. Follow this Twitter account for more medical news and updates.

The end stage: What is stage IV COPD?

Talking about “the end” when suffering from a disease may connote both positive and negative vibes. Positive when the end means the disease has been obliterated completely and negative when it means that the condition has reached its peak, and all hope for cure is futile. How the word is perceived in terms of medical implications vary, but what does it mean in cases of COPD?

Chronic Obstructive Pulmonary Disease (COPD) is described as "inflammatory lung disease affecting the airflow from the lungs." It has four stages –mild COPD, moderate COPD, severe COPD, and very severe COPD, which is also known as the end stage.

                                                             
                                                        Image Source: Timeinc.net

Very severe COPD is the fourth stage of the disease. Respiratory failure caused by either low blood oxygen or high carbon dioxide levels and signs of heart failure exist during this stage. This is regarded as the end stage because exacerbations may occur at least three times within the year, leading to the overall health of the patient becoming highly at risk.

Because of the various complications that occur during stage IV COPD, it is said that people die "with" their disease and not from it. Researches show that COPD is not the primary cause of the death, but other medical conditions that a patient also acquires while battling COPD. Lung cancer and heart failure are the usual medical conditions that cause death, and not COPD itself.

                                                         
                                                             Image source: Temple.edu

Studies also show that the condition of COPD may still improve even after reaching the end stage with the help of bronchodilators and corticosteroids. Continuing with proper health care, quitting smoking, and avoiding lung irritants will also greatly help in dealing with the end stage.

 Dr. Lisa Marie Cannon specializes in pulmonary diseases and critical care. For more articles about pulmonary diseases, visit this blog.

The Importance of Indoor Air Quality to Pulmonary Health

There are airborne causes behind the many diseases that affect the respiratory tract, such as the common cold and life-threatening diseases such as adverse forms of pneumonia.  Improving the air quality of a home or workplace is one of the many ways to guarantee long-term pulmonary health. 

Poor interior air quality, especially where household molds are involved, aggravates allergies and asthma symptoms.  Worse, poorly cleaned ventilation systems can contribute to the growth of airborne pathogens that lead to conditions like legionnaire's disease, which can be contagious enough to infect an entire building.  In extreme cases, buildings with abysmal air quality will develop sick building syndrome, where occupants would experience a sharp and usually poorly understood decline in health merely by being in the building.

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Improving indoor air quality relies on accomplishing three things: inhibiting the growth of bacteria and other pathogens, removing airborne pollutants and contaminants, and providing adequate ventilation.  Measures often involve keeping the HVAC system clean and free from mold and sources of contaminants.  Proper maintenance can also prevent the spread of pathogens by preventing the conditions that foster their growth. 

Other means of maintaining good air quality is inhibiting the growth of mold by maintaining  low humidity and regularly cleaning surfaces prone to mold infestation.  Yet another is placing indoor plants;  not only do houseplants contribute to the aesthetic quality of a home or office, some of them actively absorb significant amounts of atmospheric pollutants from the air.

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Dr. Lisa Marie Cannon is a pulmonologist who specializes in diagnosing, treating, and managing respiratory conditions like pneumonia.  Visit this Facebook page for more updates.

REPOST: Healthier lungs in California kids after pollution controls

A study conducted in California found better lung function among kids as the state's air quality improved.  This Reuters article provides the details.

(Reuters Health) - Doctors have long predicted that less air pollution will produce healthier lungs. Now a first-of-its-kind study of 2,120 children in southern California has documented dramatically better lung function growth as air quality has improved.

       

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Over a 13-year period, the proportion of children with poor lung capacity and lung health fell by half as levels of nitrogen dioxide and particulate matter dropped. The gains were seen both in youngsters who had asthma and in those who did not.

“It certainly supports the efforts that have been made over 40 years to improve air quality,” chief author Dr. James Gauderman of the Department of Preventive Medicine at the University of Southern California in Los Angeles told Reuters Health. “We would expect improvements in other urban centers to produce similar improvements in children’s health.”

The study, published in the New England Journal of Medicine, complements research showing that childhood lung function deteriorates and the risk of asthma rises as pollution levels rise.

"This is an association study, so there's always a question of cause and effect. Maybe these people got healthier on their own, ate better diets. You can never say it's an absolute proof," said Dr. Norman H. Edelman, senior consultant for scientific affairs at the American Lung Association.

        

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"But it's not a standalone study. It's based on older studies that show an association between the degree of air pollution and lung function in kids. This turns around and looks at improvement," he told Reuters Health.

Gauderman and his colleagues examined the long-term effects in children by studying three groups during three time periods between 1994 and 2011. Typically, the children entered the study around age 11 and were followed for four years, a period when the lungs are developing rapidly. All lived in the Los Angeles area, a region of the U.S. known for air pollution problems, which have been abating as a result of strict state controls.

“We looked at the proportion of children whose lung function was below 80 percent of normal. That’s a cutoff a physician will often use to flag a person for a possible issue with their lungs,” Gauderman said. While 7.9 percent of children fell into that category in 1998, the proportion had dropped to 3.6 percent by 2011.

“We certainly suspected that improving air quality would improve children’s health,” Gauderman said. “We were surprised by the magnitude of the effect that we’ve seen.”

"What's news about this is the large magnitude of the effect, from 8 percent down to 4 percent," said Edelman, who was not connected to research. "Asthma is present in 10 percent of the population and that's a major health problem. If a percentage of those kids is going to have worse asthma because the air pollution has limited their lung growth, that's a big deal."

During the study years, the air improved “dramatically,” Gauderman’s team writes in their report. For example, in 1994-1997, each cubic meter of air in one of the most-polluted communities, Mira Loma, had 31.5 micrograms of small particles called PM2.5 that penetrate deep into the lungs. By 2007-2010, Mira Loma averaged 17.8 micrograms of PM2.5 per cubic meter of air, a 43 percent decline. All five study sites had significant drops in particle pollution and nitrogen dioxide, they note.

Overall, average lung capacity increased by 91.4 milliliters for every decrease of 14.1 parts per billion in nitrogen dioxide. It rose by 65.5 ml for each decrease of 8.7 micrograms per cubic meter of particle pollution. Significant changes were not linked to ozone levels, but levels of that pollutant have not declined as dramatically over time.

       

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“There were significant effects on lung-function growth in both boys and girls, although the magnitude of the air-pollution effect was significantly larger in boys than in girls,” the researchers conclude.

“We found no significant association between growth in height and change in pollution during the study period, which indicates that our findings on lung-function growth are probably not the result of a secular trend in general development,” they write.

California has stricter pollution controls than the U.S. as a whole, but Edelman said even the federal clean air act has cleaned up a lot of pollution "and this study is part of that. We're making progress. There's still a long way to go. We still have much more unacceptable effects of air pollution than we should have."

Dr. Lisa Marie Cannon is a board certified physician who specializes in pulmonary care.  Visit this Facebook page for more access to resources on related topics. 

REPOST: E-Cigarettes May Not Help Smokers Quit Tobacco, Study Finds

Do e-cigarettes really help smokers stop the habit? Discover the truth from this Philly.com article below.

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While some proponents of "vaping" claim that smokers who try e-cigarettes may use them as a bridge to quitting smoking, a new study finds that the opposite may true.

The study, published April 16 in the American Journal of Public Health, found that smokers who used e-cigarettes were less likely to quit regular cigarettes than those who hadn't tried the devices.

A team led by Dr. Wael Al-Delaimy, chief of the division of global public health at the University of California, San Diego School of Medicine, followed 1,000 California smokers for one year.

The researchers found that smokers who said they had ever used e-cigarettes were about half as likely to cut down on their smoking and 59 percent less likely to quit, compared to those who never used e-cigarettes.

"Based on the idea that smokers use e-cigarettes to quit smoking, we hypothesized that smokers who used these products would be more successful in quitting," Al-Delaimy said. "But the research revealed the contrary."

Two anti-smoking experts said the study casts doubt on the notion of e-cigarettes as a smoking-cessation aid.

"These results confirm the potential harm e-cigarettes cause smokers, in that they may not only result in continued smoking but they may also discourage or delay quit attempts," said Patricia Folan, director of the Center for Tobacco Control at the North Shore-LIJ Health System in Great Neck, N.Y.

She believes that "the knowledge gap about electronic cigarettes is currently being filled in large part by e-cigarette industry advertising rather than scientific information."

But one industry representative took issue with the new study.

"Asking smokers about their 'ever use' of a product, and then somehow attributing that 'ever use' to their subsequent success or failure to quit smoking months or years down the line, is dishonest and unethical," said Gregory Conley, president of the American Vaping Association.

He said that to keep "credibility," the researchers should "have also sought out data about the relationship between 'ever use' of nicotine replacement therapy products like the gum and patch and a smoker's ability to quit."

Dr. Harlan Weinberg is medical director of pulmonary and critical care medicine at Northern Westchester Hospital in Mount Kisco, N.Y. He believes that more research on the issue is needed.

"There are no currently accepted guidelines for the use of e-cigarettes regarding smoking-cessation efficacy or as a cessation tool," he pointed out. "Their rapid use among the general population and as a social phenomenon require a more thorough evaluation regarding their safety and effectiveness."

Study author Al-Delaimy concurred. "We need further studies to answer why [smokers using e-cigarettes] cannot quit," he said. "One hypothesis is that smokers are receiving an increase in nicotine dose by using e-cigarettes."

Over the past two years a number of leading medical groups, including the American Heart Association, the American Cancer Society, the American Society of Clinical Oncology and the American Medical Association, have called for increased regulation of the sale and advertising of e-cigarettes, citing health concerns.

Dr. Lisa Marie Cannon is a licensed physician specializing in pulmonary care. Discover more information on internal medicine and pulmonary health from this Facebook page.